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Predicting Fluid Responsiveness in Children Undergoing Cardiac Surgery After Cardiopulmonary Bypass

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Abstract

Dynamic parameters of fluid responsiveness (FR), namely aortic blood flow velocity variation (delta V peak), left ventricular velocity-time integral variation (delta VTI), stroke volume variation, and pulse pressure variation (PPV) have demonstrated good diagnostic performance for the prediction of response to fluid loading in mechanically ventilated critically ill adult patients. We aimed to evaluate these parameters in children undergoing cardiac surgery. A retrospective observational study of mechanically ventilated patients weighing less than 20 kg who received a volume expansion (VE) of 10 ml/kg after sternal closure was conducted. A 10% cardiac index (CI) increase divided patients into 7 responders (R) and 9 non-responders (NR). Transesophageal echocardiography and Pressure Recording Analytical Method data were retrieved. The percentage CI increase was 18.6 (12)% in R and 2.9 (5.7)% in NR (p = 0.037). Prior to VE, delta V peak, delta VTI, PPV, and SPV differed between R and NR (p = 0.045, 0.043, 0.048, 0,037 and 0.044, respectively). Systolic (p = 0.004), diastolic (p = 0.002), mean blood pressure (p = 0.003), delta V peak (p = 0.03), delta VTI (p = 0.04), CI (p = 0.01), PPV (p = 0.04), SPV (p = 0.04), and dP/dt max (maximal pressure-to-time ratio) (p = 0.02) changed the following VE in R patients. Delta V peak decreased after VE in NR patients (p = 0.004). Delta VTI and PPV showed the highest predictive values, with area under receiver operator characteristic curves of 0.76 (p = 0.049) and 0.76 (p = 0.045), respectively. Delta VTI and PPV were revealed to be potential predictors of FR in ventilated children after cardiac surgery. Their combined evaluation could be useful for fluid management after sternal closure.

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Authors and Affiliations

  1. Department of Cardiology and Cardiac Surgery, Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Piazza S.Onofrio 4, 00165, Rome, Italy

    Isabella Favia, Luca Di Chiara & Zaccaria Ricci

  2. Department of Health Science, University of Florence, Florence, Italy

    Stefano Romagnoli

  3. Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Largo G. Alessandro Brambilla 3, 50134, Florence, Italy

    Stefano Romagnoli

Authors
  1. Isabella Favia
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  2. Stefano Romagnoli
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  3. Luca Di Chiara
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  4. Zaccaria Ricci
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Correspondence to Isabella Favia.

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All authors declare that they have no financial or non-financial conflict of interest.

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Formal consent is not required because we conducted a retrospective study.

Research Involving Human and Animal Participants

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Favia, I., Romagnoli, S., Di Chiara, L. et al. Predicting Fluid Responsiveness in Children Undergoing Cardiac Surgery After Cardiopulmonary Bypass. Pediatr Cardiol 38, 787–793 (2017). https://doi.org/10.1007/s00246-017-1582-0

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  • DOI: https://doi.org/10.1007/s00246-017-1582-0

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